1. Field of the Invention
This invention relates to an access device for use during endoscopic surgical procedures, and more particularly to an access device which permits a surgeon to insert his hand or a non-endoscopic surgical instrument into the body cavity during an endoscopic surgical procedure.
2. Description of the Related Art
In endoscopic procedures, surgery is performed through small incisions, usually between 5 to 15 mm, in the patient's body. The incisions provide access for a trocar or cannula device which enables the insertion of various surgical instruments into the body cavity. Specialized surgical instruments are then inserted through the trocar or cannula and entire surgical procedures, such as cholecystectomies, hysterectomies and hernia repairs, can be performed through several small incisions. The endoscopic surgical procedures dramatically reduce the pain, discomfort, period for recuperation and blood loss which result from the large incision necessary to perform a traditional open procedure. Examples of endoscopic procedures and the instruments used for such a procedure are disclosed in U.S. Pat. Nos. 5,190,561 and 5,271,385, the contents of which are incorporated herein by reference.
For an endoscopic surgical procedure to be performed in the abdominal cavity, the abdominal wall must be elevated from the organs in the intra-abdominal cavity. This is usually accomplished by inserting a Verres needle into the intra-abdominal cavity and initiating insufflation to the desired intra-abdominal pressure. In order for endoscopic procedures in the intra-abdominal cavity to be performed the insufflation must be maintained, as the abdominal wall must remain elevated from the organs in the intra-abdominal cavity. The preferred or necessary level of insufflation is often difficult to maintain because as each endoscopic surgical instrument is inserted into and removed through the trocar or cannula, insufflation gas is allowed to escape from the intra-abdominal cavity. This escape of insufflation gas and the potentially resultant surgical situation is undesirable.
While endoscopic procedures have met with tremendous acceptance, to the extent that the vast majority of cholecystectomies are performed endoscopically, the adaptation of endoscopic surgical procedures into other surgical procedures has been limited by the present need for all instruments used during an endoscopic procedure be sized to fit through the trocar or cannula device. The adaptation of other surgical procedures has further been hampered by the requirement that all objects removed from the surgical site be sized to fit through the trocar or cannula. The special endoscopic surgical instruments are different from the traditional surgical instruments which surgeons have been using for decades and have the further undesirable drawback of reduced tactility. An additional constraint imposed on the present endoscopic hand instrument is that they are quite expensive to manufacture and only a representative few instruments are available. Also, one additional drawback to endoscopic surgery is the inability of the surgeon to have his hand directly at the surgical site. The ability of the surgeon to perform some surgical techniques, such as suturing, and to touch, feel and manipulate directly at the surgical site further hinders the adaptation of endoscopic surgery to additional surgical procedures.
Numerous devices for facilitating introduction into a body cavity have heretofore been proposed in relation to various types of surgical devices and instruments. For example, U.S. Pat. No. 5,242,409 discloses an access device for accommodating the introduction of an instrument with a bent configuration and having a cannula and a hub disposed at the proximal end thereof. U.S. Pat. No. 5,217,441 discloses a guide tube positioning device for positioning a guide tube relative to the body once the desired penetration has been obtained. U.S. Pat. No. 5,300,036 discloses a trocar having multiple converters for adopting the size of the annular seal located on the trocar tube to different sizes of instruments. This allows the same trocar body subassembly and trocar tube subassembly to be used for various sizes of surgical tools. U.S. Pat. No. 5,209,736 discloses a trocar assembly having trocar tubes of different diameters to accommodate various diameters of instruments. The lumen of the outer trocar tube and, therefore, the largest instrument which could be passed therethrough is approximately 50 mm.
The devices discussed above were all designed to be used in endoscopic surgical procedures and all require that instruments inserted through them be appropriately configured and dimensioned and have a diameter not larger than approximately 50 mm.
There is a need for an access device and method of utilizing such devices that permits the insertion of a surgeon or nurse's hand and other large diameter instruments through the abdominal wall to the surgical site while also maintaining insufflation. Such a device would increase the kinds of surgical procedures that could be performed endoscopically by allowing a surgeon to advance his hand to the surgical site as well as to use traditional open procedure surgical instruments. Also, such a device would permit the removal of tumors or other relatively large body parts from the body through an opening in the abdominal wall.
Because endoscopic procedures are more common than laparoscopic procedures, the present invention shall be discussed in terms of endoscopic procedures and apparatus. However, use herein of terms such as "endoscopic" and "endoscopically", among others, should not be construed to limit the present invention to an apparatus for use only in conjunction with an endoscopic tube. To the contrary, it is believed the present invention may find use in any procedure where access is limited to a small incision, including but not limited to laparoscopic procedures.
3. Objects of the Invention
Accordingly, it is one object of the present invention to provide an access device for use during endoscopic surgery.
A further object of the invention is to provide an access device for use during endoscopic surgery and which is adapted and configured to receive a surgeon's hand or large instrument therethrough.
Another object of the invention is to provide an access device which maintains insufflation during an endoscopic surgical procedure and also permits the passage of a surgeon's hand or surgical instrument or other similarly sized object through the abdominal wall and into the body cavity.